• Optimizing atrial fibrillation...

Treffer: Optimizing atrial fibrillation management using a novel patient-level computational model.

Title:
Optimizing atrial fibrillation management using a novel patient-level computational model.
Authors:
Cai M; Department of Cardiology, Cardiovascular Research Institute Maastricht, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, the Netherlands., Barrios-Espinosa C; Department of Cardiology, Cardiovascular Research Institute Maastricht, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, the Netherlands; Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany., Rienstra M; Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands., Crijns HJGM; Department of Cardiology, Cardiovascular Research Institute Maastricht, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, the Netherlands., Schotten U; Department of Cardiology, Cardiovascular Research Institute Maastricht, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, the Netherlands; Department of Physiology, Cardiovascular Research Institute Maastricht, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, the Netherlands., Heijman J; Department of Cardiology, Cardiovascular Research Institute Maastricht, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, the Netherlands; Gottfried Schatz Research Center, Division of Medical Physics & Biophysics, Medical University of Graz, Graz, Austria. Electronic address: jordi.heijman@medunigraz.at.
Source:
Med (New York, N.Y.) [Med] 2026 Jan 09; Vol. 7 (1), pp. 100896. Date of Electronic Publication: 2025 Oct 31.
Publication Type:
Journal Article
Language:
English
Journal Info:
Publisher: Cell Press Country of Publication: United States NLM ID: 101769215 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2666-6340 (Electronic) Linking ISSN: 26666340 NLM ISO Abbreviation: Med Subsets: MEDLINE
Imprint Name(s):
Original Publication: [New York] : Cell Press, [2020]-
MeSH Terms:
Atrial Fibrillation*/diagnosis , Atrial Fibrillation*/complications , Atrial Fibrillation*/drug therapy , Anticoagulants*/therapeutic use , Anticoagulants*/administration & dosage , Stroke*/prevention & control , Stroke*/etiology , Computer Simulation*, Humans ; Male ; Female ; Middle Aged ; Markov Chains ; Aged ; Electrocardiography ; Early Diagnosis ; Mass Screening/methods
Contributed Indexing:
Keywords: Markov model; Translation to patients; atrial fibrillation; computational modeling; in silico trials; oral anticoagulation therapy; screening; simulation; stroke
Substance Nomenclature:
0 (Anticoagulants)
Entry Date(s):
Date Created: 20251101 Date Completed: 20260110 Latest Revision: 20260110
Update Code:
20260111
DOI:
10.1016/j.medj.2025.100896
PMID:
41175878
Database:
MEDLINE

Weitere Informationen

Background: The dynamic, heterogeneous nature of atrial fibrillation (AF) episodes and poor symptom-rhythm correlation make early AF detection challenging. The optimal screening strategy for early AF detection and its role in stroke prevention are unknown.
Methods: To analyze the impact of screening-mediated AF detection on stroke risk, a Markov-like computer model was created that captured seven clinical states. AF-related atrial remodeling was incorporated, which influenced the age-/sex-dependent transition probabilities between states. Model calibration/validation was performed by replicating clinical studies. The effect of screening strategies on early AF diagnosis and subsequent modulation of stroke rate by simulated oral anticoagulation were assessed.
Findings: The model simulates the entire lifetime of virtual patients with 30-min resolution and provides precise information on the occurrence of AF episodes and clinical outcomes. It replicates numerous age/sex-specific episode- and population-level AF metrics and clinical outcomes. The benefits of intermittent AF screening were frequency and duration dependent, with systematic thrice-daily single electrocardiogram providing the highest detection rates. Screening groups had comparable 5-year and lower 25-year stroke rates than the control group. These differences were increased by more effective anticoagulation therapy, in patients with higher baseline stroke risk, or with delayed clinical AF diagnosis.
Conclusions: We present a novel computational patient-level AF model consistent with a large body of real-world data, enabling for the first time the systematic assessment of AF-management strategies. More frequent and longer screening has higher AF-detection rates, but stroke reduction is highly dependent on patients' and healthcare-systems' characteristics.
Funding: Funding information is shown in the acknowledgments section.
(Copyright © 2025 The Author(s). Published by Elsevier Inc. All rights reserved.)

Declaration of interests U.S. received consultancy fees or honoraria from Università della Svizzera Italiana (USI, Switzerland), Roche Diagnostics (Switzerland), EP Solutions Inc. (Switzerland), Johnson & Johnson Medical Limited (United Kingdom), and Bayer Healthcare (Germany). U.S. is co-founder and shareholder of YourRhythmics BV, a spin-off company of the University Maastricht.